Agenda of the June 20, 2012 NCVHS Subcommittee on Standards Hearing

Final Agenda

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

Subcommittee on Standards

Administrative Transaction Standards, Code Sets and Operating Rules
Industry Status of Planning, Transitioning and Implementation

Doubletree Hotel
8727 Coleville Road
Silver Spring, MD 20910

June 20, 2012

Printable Acrobat Agenda

Transcript

Audio Recording [MP3]

Wednesday, June 20
8:00 – 8:15am	Call to order, Welcome, Introductions	Dr. Walter Suarez and Mr. Ob Soonthornsima, Co-Chairs
8:15- 9:45am	Panel 1 – 5010/D.0 and 3.0 – Issues, Approaches to Solutions and Lessons Learned Overall Industry Update – Laurie Darst, WEDI View Laurie Darst Testimony Provider Perspective – Rob Tennant, MGMA View Rob Tennant Presentation Health Plan Perspective – Jordan Firfer, BCBSFL View Jordan Firfer Presentation View Jordan Firfer Testimony Medicare Fee-for-Service – Cathy Carter, Medicare View Cathy Carter Presentation Clearinghouses – Debbi Meisner, Emdeon View Debbi Meisner Testimony Billing Services – Holly Louie, HBMA View Holly Louie Testimony Vendors – Tim McMullen, The Cooperative Exchange View Tim Mullen Presentation View Tim Mullen Testimony NCPDP – Annette Gabel, Express Scripts View Annette Gabel Presentation View Annette Gabel Testimony
9:45-10:00am	BREAK
11:00 – 11:20am	Panel 2 – Operating Rules for Eligibility and Claim Status – Preparing for Implementation Health Plan Perspective – Tim Kaja, United Health and Janet Jackson, BCBSNC View Tim Kaja Testimony View Janet Jackson Testimony Provider Perspective – Tammy Banks, AMA View Tammy Banks Testimony Industry Engagement/Education – Deb Strickland, WEDI View Deb Strickland Presentation View Deb Strickland Testimony Authoring Entity – Gwen Lohse, CAQH CORE View Gwen Lohse Presentation View Gwen Lohse Testimony
11:00 – 11:20 am	Panel 3 – DSMO Update Update – Stacy Barber, DSMO View Stacy Barber Testimony View Stacy Barber Handout
11:20 – 12:30 pm	Panel 4 – ICD-10 – Strategies and Recommended Milestones to Achieve a Successful Transition Overview Remarks – Simon Cohn, Kaiser Permanente Former Chair, NCVHS View Simon Cohn Testimony AHIMA – Dan Rode, AHIMA View Dan Rode Testimony Provider Perspective – high level – Stanley Nachimson, HIMSS, Rhonda Buckholttz, AAPC, and Mona Reimers, Practice View Stanley Nachimson Presentation View Rhonda Buckholttz Presentation View Mona Reimers Presentation Health Plan Perspective – Dennis Winkler, BCBSMI and Sid Herbert, AHIP View Dennis Winkler Presentation View Sid Hebert Testimony Billing Services – Holly Louie, HBMA View Holly Louie Testimony
12:30-1:15 pm	LUNCH BREAK
1:15 – 2:10 pm	Panel 5: Dental Code Set Updates and Considerations ADA – Dave Preble, ADA View Dave Preble Presentation View Dave Preble Testimony Dental Plans – Tim Brown, NADP and William Kohn, Delta Dental Plans View Tim Brown Testimony View William Kohn Testimony CMS – Lynn DouglasMouden, CMCS View Lynn DouglasMouden Testimony
2:10 – 3:00 pm	Panel 6: A Unique Device Identifier and its Relationship to Administrative Transactions FDA representatives – Terri Reed, FDA View Terri Reed Presentation Standards Organization – Margaret Weiker, X12 View Margaret Weiker Presentation California Pilot – Marchel Burgess, Sara Rivera, and Pansy Watson, CA Dept of Health Care Services View California Department of Health Care Services Presentation
3:00 – 3:15 pm	BREAK
3:15 – 4:30 pm	Panel 7: ACA Health Plan Compliance Certification – Initial Ideas Testing Issues – Jim Daley, WEDI and Lee Barrett, EHNAC View Jim Daley Presentation View Lee Barrett Presentation View Lee Barrett Testimony View Lee Barrett Handout Health Plans – Jeanette Thornton, AHIP View Jeanette Thornton Testimony Certification strategies – Merri-Lee Stine, Aetna View Merri-Lee Stine Testimony
4:30 – 4:50 pm	Subcommittee Discussion
4:50 – 5:00 pm	Public Input View American Medical Association Testimony View Edifecs Testimony View America’s Health Insurance Plans Testimony
5:00 pm	Adjournment

PURPOSE:

• 5010/D.0/3.0
  • Review the industry status of implementation of 5010/D.0/3.0
  • Discuss identified implementation issues and approaches to address them
  • Identify/discuss lessons learned with respect to transition and initial implementation issues
• Operating Rules – Eligibility and Claim Status
  • Review industry status and issues, and identify opportunities and milestones regarding the pending implementation of operating rules for eligibility and claim status by 1/1/2013
• DSMO Update
  • Review and discuss the 2012 report from the DSMO to NCVHS
• ICD-10
  • Review summary of public comments received by CMS on proposed extension
  • Identify and discuss key industry milestones needed to ensure successful transition to ICD-10, considering the pending 1-year delay in compliance
• Unique Device Identifier
  • Review background, purpose, benefits of adoption a unique device identifier, and status of adoption of regulations (FDA)
  • Identify and discuss business and technical issues related to the use of a unique device identifier in administrative transactions
• Dental Code Set Update
  • Identify/discuss new/emerging issues related to the purpose, benefit, process for adopting new versions of the standard dental code set being used in administrative transactions
• ACA Health Plan Compliance Certification
  • Review and discuss industry perspectives on possible approaches for achieving ACA health plan compliance certification, as input to HHS proposed regulations on the topic

QUESTIONS TO TESTIFIERS

5010/D.0/3.0 (Panels 1, 2, 3)

• How is the implementation of 5010, D.0, 3.0 going, from your perspective
• What are the most important business and technical issues still remaining for each transaction (claims, claims payment, eligibility, claim status, etc), and how would you recommend addressing them
• What are the top 2 or 3 lessons learned from the first national transition to a new version of existing standards
• Anything else you would like to bring up regarding the implementation of 5010, D.0, 3.0

Operating Rules for Eligibility and Claim Status

• How is the transition to the new required operating rules for eligibility and claim status going, from your perspective
• What have been your (your organization, the organizations you represent) experience with internal preparation and transition to the new required operating rules – including business and technical process changes
• Have you identified any business or technical issues with respect to the operating rules?
• Anything else you would like to bring up regarding the preparation/transition to the new operating rules for eligibility and claim status

ICD-10

• (Dr. Cohn) Discuss the experience of transitioning to ICD-10 by a large, integrated health care organization; the need for an enterprise-wide commitment, benefits of adopting ICD-10, business, technical, organizational challenges; recommendations on defining transition milestones to ensure success
• (CMS) Overview of comments received on ICD-10 proposed delay; timeline for completing regulatory process for delay
• (Others)
  • What are the most critical industry milestones to achieve between now and the proposed new compliance deadline to ensure a successful transition
  • What can be done to maintain industry momentum on the transitioning to ICD-10, and avoid organizations moving to put-off ongoing work due to the delay
  • What can be done to facilitate end-to-end testing during the remaining transition period
• Anything else you would like to bring up regarding the delay of ICD-10, the milestones to complete during the remaining transition period

Unique Device Identifier

• (FDA) Overview of unique device identifier, purpose, benefits, status of regulations
• (Others) What are the business and technical relationships, needs, issues, gaps, regarding a unique device identifier and the administrative transactions (i.e., documentation of device/product on a claim)
• Anything else you would like to bring up regarding the adoption and implementation of a unique device identifier vis-à-vis the HIPAA administrative transactions

Dental Code Set Update

• What is the current status of code set development and the process for adopting new codes, and a new version of the standard code set
• What are the current/new/emerging issues with the existing code set, and the process and issues associated with the adoption of a new version of the code set

ACA Health Plan Compliance Certification

• Please provide your perspectives on the possible methods/mechanisms CMS/HHS could use to obtain adequate documentation certifying health plan compliance with standards/operating rules, including documentation showing the plan has completed end-to-end testing
• Provide your perspectives on how document health plans are ensuring that their contractors (BAs, others) are complying with any applicable certification and compliance requirement

Should you require reasonable accommodation, please contact the CDC Office of Equal Employment Opportunity on (301) 458-4EEO (4336) as soon as possible.

Times, topics, and speakers are subject to change.  For final agenda, please call 301-458-4200 at NCHS or visit the NCVHS Home Page at http://www.ncvhs.hhs.gov

June 28, 2012